Provider Demographics
NPI:1952846636
Name:AVA CARES, LLC
Entity Type:Organization
Organization Name:AVA CARES, LLC
Other - Org Name:AVA CARES VI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-300-6177
Mailing Address - Street 1:10107 PADDOCK OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8741
Mailing Address - Country:US
Mailing Address - Phone:813-300-6177
Mailing Address - Fax:
Practice Address - Street 1:1108 BLACK KNIGHT DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-5800
Practice Address - Country:US
Practice Address - Phone:813-300-6177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12747310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility